6
The Auto Claim Experience and Accident Worksheet Personal Risk Services

The Auto Claim Experience and Accident Worksheet€¦ · • Exchange insurance and contact information with anyone involved or witnesses to the accident. Use the Accident Worksheet

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Page 1: The Auto Claim Experience and Accident Worksheet€¦ · • Exchange insurance and contact information with anyone involved or witnesses to the accident. Use the Accident Worksheet

The Auto Claim Experience and Accident Worksheet

Personal Risk Services

We will help you through the auto claim process quickly and efficiently with professionalism and compassion

Here When You Need Us You have just been through the stressful and unsettling chain of events resulting from a car accident We handle auto claims every day but understand that the process may be new for you We are here to help you and will do all we can to ensure your claim goes as smoothly as possible

Getting Started

Following an Accident bull Call 911 or the police for emergency

assistance bull Remain at the scene of the accident bull Take photos of the accident scene and

vehicles involved bull Exchange insurance and contact

information with anyone involved or witnesses to the accident

Use the Accident Worksheet to gather important information

Report Your Claim

Phone 18002524670 for Chubb Masterpiecereg policyholders

18009457461 for ACE PRS and Firemanrsquos Fund policyholders

Online wwwchubbcom

Or contact your local Chubb agent who can submit a claim on your behalf

What To Expect

Responsive Service

Your claim is important to us and a Chubb Claim Adjuster will make every effort to contact you within six hours of receiving your initial report of a claim The adjuster

will carefully guide you through the process and will be your primary point of contact to answer any questions that may arise Additionally your local Chubb agent has online access to your claim and will receive automated updates throughout the process

Thorough Handling of Your Claim

To help determine available coverage the Chubb Claim Adjuster will ask you questions pertinent to the claim and will review the information along with your policy Your adjuster will work with you to obtain repair estimates inspect the vehicle damages andor coordinate a rental car depending on the circumstances

Deductible Recovery on Partial-Fault or Not-at-Fault Accidents

If other parties are responsible for the damage to your automobile our recovery department will work on your behalf in an effort to reimburse your deductible from the responsible party this process is known as subrogation The recovery department manages your claim following our payment for damages and will review the facts surrounding your case to determine possible subrogation If we successfully recover any monies your deductible will be refunded in part or whole based upon the recovered amount andor local laws Depending on the circumstances of your claim it is not uncommon for recovery to take several months to reach a settlement with the responsible party andor their insurance provider

96 of our Masterpiece Automobile Insurance customers are contacted by their Claim Adjuster within six hours of Chubb being notified of their claim

Technical Expertise

Behind the scenes Chubbrsquos experienced team of industry certified Auto Reinspectors monitors the work of repair facilities Located in offices throughout the country each reinspector reviews selected estimates and repairs assuring accuracy and quality In addition to working with many of the leading automotive manufacturers the team provides in-house expertise on the latest automotive technology along with their extensive knowledge on exotic and collector vehicles

Understanding The Details

Your Deductible

Your Chubb Claim Adjuster will explain your deductible and how it applies to your specific claim If you have Agreed Value Coverage and your car is determined to be a covered total loss your deductible will be waived Chubbrsquos Specialized Total Loss Unit will work toward a prompt resolution

Your Repair Shop Is Your Choice

With Chubb who will repair your damaged vehicle is always up to you Perhaps you prefer an auto body shop you have used in the past You can also choose from our network of reputable independent collision repair shops and dealerships that specialize in high-end vehicles Many of our preferred repair shops are also manufacturer certified

Should you choose from one of our preferred repair shops a representative from the shop will make every effort to contact you within 24 hours to manage your auto repair process provide updates and make final arrangements once the work is complete While we allow you to choose any auto body shop for your repairs we will guarantee the workmanship of repairs done at a preferred shop for as long as you own or lease your vehicle

Your Settlement

We make every effort to issue your claim payment within 48 hours of an agreed settlement amount

Rental Coverage

Your Chubb Claim Adjuster will work with one of our preferred independent rental vendors to arrange a replacement vehicle if your car is in the shop for repairs following a covered accident or if it is totaled or stolen We will reimburse the vendor directly for your rental car so you wonrsquot have to worry about the bill Rental services are available nationwide and many of our preferred shops have rental vehicles at their facilities Of course you can also choose to work with any rental car agency you prefer

2015 results only

-

We Value Your Feedback Sending Chubb Documents

We strive to live up to our high standards of service excellence with every claim A survey will be sent on all paid and closed claims and we look forward to hearing back from you

Ninety six percent of our Masterpiece Automobile Insurance customers who have had a paid claim and responded to our survey indicate they were ldquohighly satisfiedrdquo with their auto insurance claim experience

We value your business and your feedback is important to us

Your Records

We recommend that you create a file for important information related to your claim Throughout this process keep records of your claim documents to share with your agent and Chubb Claim Adjuster including

bull Your claim number bull Your Chubb Claim Adjusterrsquos name

and contact information bull Contact and insurance information

for other parties involved including witnesses

bull Repair estimates and bills bull Photographs of damage bull Receipts

Online Upload Using your claim reference number you can upload important documents directly to your claim file Visit Chubbrsquos claim document upload application at wwwchubbcomuploadclaimdoc

View Your Claim Details Online

When you register your Chubb Masterpiece accounts online you can access and manage your claim anytime anywhere Log in to your online account and click the Your Claims folder to

bull Review the details of your claim bull Locate your Chubb Claim Adjusterrsquos

contact information bull Check the status of your claim learn

about the process and understand next steps

bull Upload documents and photos to your claim file

bull Locate a nearby Chubb network collision repair facility

bull Review payment details bull Get answers to common claims

questions

If you have not done so already you can register your policies online at wwwchubbcom

Based on Chubb Masterpiece Automobile claim survey results from 2015

Evaluations reports and recommendations are made solely to assist Chubb in underwriting and loss control Evaluation of any hazard or condition does not mean that it is covered under any policy No warranties or representations of any kind are made to any party Neither Chubb nor its employees or agents shall be liable to any party for the use of any information or statements made or contained in any evaluation report or recommendation

copy2016 Chubb is the marketing name used to refer to subsidiaries of Chubb Limited providing insurance and related services For a list of these subsidiaries please visit our website at newchubbcom Insurance provided by US based Chubb underwriting companies This literature is descriptive only Coverage is subject to the language of the policies as actually issued Chubb Personal Risk Services PO Box 1600 Whitehouse Station NJ 08889-1600 Form 01-01-1367 (Rev 816)

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Accident Worksheet

The moments following an accident can be difficult but it is important to remain calm and capture as much information at the scene of an accident as possible Report all accidents to Chubb or your agent immediately

18002524670 for Chubb Masterpiece policyholders 18009457461 for ACE PRS and Firemanrsquos Fund policyholders

Accident Checklist

Take photos Your vehicle and any other vehicles involved in the accident ndash including photos of the license plates

General accident scene including other objects the car came in contact with street signs traffic signals intersections etc

Take notes Describe the accident and the damage to your car and any other vehicle(s) person(s) or object(s) involved

Obtain vehicle and driver information for others involved in the accident andor witnesses including name contact and insurance information

Name and precinct of the police officer at the scene of the accident

Accident Notes

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Accident Notes

Evaluations reports and recommendations are made solely to assist Chubb in underwriting and loss control Evaluation of any hazard or condition does not mean that it is covered under any policy No warranties or representations of any kind are made to any party Neither Chubb nor its employees or agents shall be liable to any party for the use of any information or statements made or contained in any evaluation report or recommendation

copy2016 Chubb is the marketing name used to refer to subsidiaries of Chubb Limited providing insurance and related services For a list of these subsidiaries please visit our website at newchubbcom Insurance provided by US based Chubb underwriting companies This literature is descriptive only Coverage is subject to the language of the policies as actually issued Chubb Personal Risk Services PO Box 1600 Whitehouse Station NJ 08889-1600 Form 01-01-1368 (Rev 816)

Page 2: The Auto Claim Experience and Accident Worksheet€¦ · • Exchange insurance and contact information with anyone involved or witnesses to the accident. Use the Accident Worksheet

We will help you through the auto claim process quickly and efficiently with professionalism and compassion

Here When You Need Us You have just been through the stressful and unsettling chain of events resulting from a car accident We handle auto claims every day but understand that the process may be new for you We are here to help you and will do all we can to ensure your claim goes as smoothly as possible

Getting Started

Following an Accident bull Call 911 or the police for emergency

assistance bull Remain at the scene of the accident bull Take photos of the accident scene and

vehicles involved bull Exchange insurance and contact

information with anyone involved or witnesses to the accident

Use the Accident Worksheet to gather important information

Report Your Claim

Phone 18002524670 for Chubb Masterpiecereg policyholders

18009457461 for ACE PRS and Firemanrsquos Fund policyholders

Online wwwchubbcom

Or contact your local Chubb agent who can submit a claim on your behalf

What To Expect

Responsive Service

Your claim is important to us and a Chubb Claim Adjuster will make every effort to contact you within six hours of receiving your initial report of a claim The adjuster

will carefully guide you through the process and will be your primary point of contact to answer any questions that may arise Additionally your local Chubb agent has online access to your claim and will receive automated updates throughout the process

Thorough Handling of Your Claim

To help determine available coverage the Chubb Claim Adjuster will ask you questions pertinent to the claim and will review the information along with your policy Your adjuster will work with you to obtain repair estimates inspect the vehicle damages andor coordinate a rental car depending on the circumstances

Deductible Recovery on Partial-Fault or Not-at-Fault Accidents

If other parties are responsible for the damage to your automobile our recovery department will work on your behalf in an effort to reimburse your deductible from the responsible party this process is known as subrogation The recovery department manages your claim following our payment for damages and will review the facts surrounding your case to determine possible subrogation If we successfully recover any monies your deductible will be refunded in part or whole based upon the recovered amount andor local laws Depending on the circumstances of your claim it is not uncommon for recovery to take several months to reach a settlement with the responsible party andor their insurance provider

96 of our Masterpiece Automobile Insurance customers are contacted by their Claim Adjuster within six hours of Chubb being notified of their claim

Technical Expertise

Behind the scenes Chubbrsquos experienced team of industry certified Auto Reinspectors monitors the work of repair facilities Located in offices throughout the country each reinspector reviews selected estimates and repairs assuring accuracy and quality In addition to working with many of the leading automotive manufacturers the team provides in-house expertise on the latest automotive technology along with their extensive knowledge on exotic and collector vehicles

Understanding The Details

Your Deductible

Your Chubb Claim Adjuster will explain your deductible and how it applies to your specific claim If you have Agreed Value Coverage and your car is determined to be a covered total loss your deductible will be waived Chubbrsquos Specialized Total Loss Unit will work toward a prompt resolution

Your Repair Shop Is Your Choice

With Chubb who will repair your damaged vehicle is always up to you Perhaps you prefer an auto body shop you have used in the past You can also choose from our network of reputable independent collision repair shops and dealerships that specialize in high-end vehicles Many of our preferred repair shops are also manufacturer certified

Should you choose from one of our preferred repair shops a representative from the shop will make every effort to contact you within 24 hours to manage your auto repair process provide updates and make final arrangements once the work is complete While we allow you to choose any auto body shop for your repairs we will guarantee the workmanship of repairs done at a preferred shop for as long as you own or lease your vehicle

Your Settlement

We make every effort to issue your claim payment within 48 hours of an agreed settlement amount

Rental Coverage

Your Chubb Claim Adjuster will work with one of our preferred independent rental vendors to arrange a replacement vehicle if your car is in the shop for repairs following a covered accident or if it is totaled or stolen We will reimburse the vendor directly for your rental car so you wonrsquot have to worry about the bill Rental services are available nationwide and many of our preferred shops have rental vehicles at their facilities Of course you can also choose to work with any rental car agency you prefer

2015 results only

-

We Value Your Feedback Sending Chubb Documents

We strive to live up to our high standards of service excellence with every claim A survey will be sent on all paid and closed claims and we look forward to hearing back from you

Ninety six percent of our Masterpiece Automobile Insurance customers who have had a paid claim and responded to our survey indicate they were ldquohighly satisfiedrdquo with their auto insurance claim experience

We value your business and your feedback is important to us

Your Records

We recommend that you create a file for important information related to your claim Throughout this process keep records of your claim documents to share with your agent and Chubb Claim Adjuster including

bull Your claim number bull Your Chubb Claim Adjusterrsquos name

and contact information bull Contact and insurance information

for other parties involved including witnesses

bull Repair estimates and bills bull Photographs of damage bull Receipts

Online Upload Using your claim reference number you can upload important documents directly to your claim file Visit Chubbrsquos claim document upload application at wwwchubbcomuploadclaimdoc

View Your Claim Details Online

When you register your Chubb Masterpiece accounts online you can access and manage your claim anytime anywhere Log in to your online account and click the Your Claims folder to

bull Review the details of your claim bull Locate your Chubb Claim Adjusterrsquos

contact information bull Check the status of your claim learn

about the process and understand next steps

bull Upload documents and photos to your claim file

bull Locate a nearby Chubb network collision repair facility

bull Review payment details bull Get answers to common claims

questions

If you have not done so already you can register your policies online at wwwchubbcom

Based on Chubb Masterpiece Automobile claim survey results from 2015

Evaluations reports and recommendations are made solely to assist Chubb in underwriting and loss control Evaluation of any hazard or condition does not mean that it is covered under any policy No warranties or representations of any kind are made to any party Neither Chubb nor its employees or agents shall be liable to any party for the use of any information or statements made or contained in any evaluation report or recommendation

copy2016 Chubb is the marketing name used to refer to subsidiaries of Chubb Limited providing insurance and related services For a list of these subsidiaries please visit our website at newchubbcom Insurance provided by US based Chubb underwriting companies This literature is descriptive only Coverage is subject to the language of the policies as actually issued Chubb Personal Risk Services PO Box 1600 Whitehouse Station NJ 08889-1600 Form 01-01-1367 (Rev 816)

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Accident Worksheet

The moments following an accident can be difficult but it is important to remain calm and capture as much information at the scene of an accident as possible Report all accidents to Chubb or your agent immediately

18002524670 for Chubb Masterpiece policyholders 18009457461 for ACE PRS and Firemanrsquos Fund policyholders

Accident Checklist

Take photos Your vehicle and any other vehicles involved in the accident ndash including photos of the license plates

General accident scene including other objects the car came in contact with street signs traffic signals intersections etc

Take notes Describe the accident and the damage to your car and any other vehicle(s) person(s) or object(s) involved

Obtain vehicle and driver information for others involved in the accident andor witnesses including name contact and insurance information

Name and precinct of the police officer at the scene of the accident

Accident Notes

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Accident Notes

Evaluations reports and recommendations are made solely to assist Chubb in underwriting and loss control Evaluation of any hazard or condition does not mean that it is covered under any policy No warranties or representations of any kind are made to any party Neither Chubb nor its employees or agents shall be liable to any party for the use of any information or statements made or contained in any evaluation report or recommendation

copy2016 Chubb is the marketing name used to refer to subsidiaries of Chubb Limited providing insurance and related services For a list of these subsidiaries please visit our website at newchubbcom Insurance provided by US based Chubb underwriting companies This literature is descriptive only Coverage is subject to the language of the policies as actually issued Chubb Personal Risk Services PO Box 1600 Whitehouse Station NJ 08889-1600 Form 01-01-1368 (Rev 816)

Page 3: The Auto Claim Experience and Accident Worksheet€¦ · • Exchange insurance and contact information with anyone involved or witnesses to the accident. Use the Accident Worksheet

96 of our Masterpiece Automobile Insurance customers are contacted by their Claim Adjuster within six hours of Chubb being notified of their claim

Technical Expertise

Behind the scenes Chubbrsquos experienced team of industry certified Auto Reinspectors monitors the work of repair facilities Located in offices throughout the country each reinspector reviews selected estimates and repairs assuring accuracy and quality In addition to working with many of the leading automotive manufacturers the team provides in-house expertise on the latest automotive technology along with their extensive knowledge on exotic and collector vehicles

Understanding The Details

Your Deductible

Your Chubb Claim Adjuster will explain your deductible and how it applies to your specific claim If you have Agreed Value Coverage and your car is determined to be a covered total loss your deductible will be waived Chubbrsquos Specialized Total Loss Unit will work toward a prompt resolution

Your Repair Shop Is Your Choice

With Chubb who will repair your damaged vehicle is always up to you Perhaps you prefer an auto body shop you have used in the past You can also choose from our network of reputable independent collision repair shops and dealerships that specialize in high-end vehicles Many of our preferred repair shops are also manufacturer certified

Should you choose from one of our preferred repair shops a representative from the shop will make every effort to contact you within 24 hours to manage your auto repair process provide updates and make final arrangements once the work is complete While we allow you to choose any auto body shop for your repairs we will guarantee the workmanship of repairs done at a preferred shop for as long as you own or lease your vehicle

Your Settlement

We make every effort to issue your claim payment within 48 hours of an agreed settlement amount

Rental Coverage

Your Chubb Claim Adjuster will work with one of our preferred independent rental vendors to arrange a replacement vehicle if your car is in the shop for repairs following a covered accident or if it is totaled or stolen We will reimburse the vendor directly for your rental car so you wonrsquot have to worry about the bill Rental services are available nationwide and many of our preferred shops have rental vehicles at their facilities Of course you can also choose to work with any rental car agency you prefer

2015 results only

-

We Value Your Feedback Sending Chubb Documents

We strive to live up to our high standards of service excellence with every claim A survey will be sent on all paid and closed claims and we look forward to hearing back from you

Ninety six percent of our Masterpiece Automobile Insurance customers who have had a paid claim and responded to our survey indicate they were ldquohighly satisfiedrdquo with their auto insurance claim experience

We value your business and your feedback is important to us

Your Records

We recommend that you create a file for important information related to your claim Throughout this process keep records of your claim documents to share with your agent and Chubb Claim Adjuster including

bull Your claim number bull Your Chubb Claim Adjusterrsquos name

and contact information bull Contact and insurance information

for other parties involved including witnesses

bull Repair estimates and bills bull Photographs of damage bull Receipts

Online Upload Using your claim reference number you can upload important documents directly to your claim file Visit Chubbrsquos claim document upload application at wwwchubbcomuploadclaimdoc

View Your Claim Details Online

When you register your Chubb Masterpiece accounts online you can access and manage your claim anytime anywhere Log in to your online account and click the Your Claims folder to

bull Review the details of your claim bull Locate your Chubb Claim Adjusterrsquos

contact information bull Check the status of your claim learn

about the process and understand next steps

bull Upload documents and photos to your claim file

bull Locate a nearby Chubb network collision repair facility

bull Review payment details bull Get answers to common claims

questions

If you have not done so already you can register your policies online at wwwchubbcom

Based on Chubb Masterpiece Automobile claim survey results from 2015

Evaluations reports and recommendations are made solely to assist Chubb in underwriting and loss control Evaluation of any hazard or condition does not mean that it is covered under any policy No warranties or representations of any kind are made to any party Neither Chubb nor its employees or agents shall be liable to any party for the use of any information or statements made or contained in any evaluation report or recommendation

copy2016 Chubb is the marketing name used to refer to subsidiaries of Chubb Limited providing insurance and related services For a list of these subsidiaries please visit our website at newchubbcom Insurance provided by US based Chubb underwriting companies This literature is descriptive only Coverage is subject to the language of the policies as actually issued Chubb Personal Risk Services PO Box 1600 Whitehouse Station NJ 08889-1600 Form 01-01-1367 (Rev 816)

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Accident Worksheet

The moments following an accident can be difficult but it is important to remain calm and capture as much information at the scene of an accident as possible Report all accidents to Chubb or your agent immediately

18002524670 for Chubb Masterpiece policyholders 18009457461 for ACE PRS and Firemanrsquos Fund policyholders

Accident Checklist

Take photos Your vehicle and any other vehicles involved in the accident ndash including photos of the license plates

General accident scene including other objects the car came in contact with street signs traffic signals intersections etc

Take notes Describe the accident and the damage to your car and any other vehicle(s) person(s) or object(s) involved

Obtain vehicle and driver information for others involved in the accident andor witnesses including name contact and insurance information

Name and precinct of the police officer at the scene of the accident

Accident Notes

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Accident Notes

Evaluations reports and recommendations are made solely to assist Chubb in underwriting and loss control Evaluation of any hazard or condition does not mean that it is covered under any policy No warranties or representations of any kind are made to any party Neither Chubb nor its employees or agents shall be liable to any party for the use of any information or statements made or contained in any evaluation report or recommendation

copy2016 Chubb is the marketing name used to refer to subsidiaries of Chubb Limited providing insurance and related services For a list of these subsidiaries please visit our website at newchubbcom Insurance provided by US based Chubb underwriting companies This literature is descriptive only Coverage is subject to the language of the policies as actually issued Chubb Personal Risk Services PO Box 1600 Whitehouse Station NJ 08889-1600 Form 01-01-1368 (Rev 816)

Page 4: The Auto Claim Experience and Accident Worksheet€¦ · • Exchange insurance and contact information with anyone involved or witnesses to the accident. Use the Accident Worksheet

-

We Value Your Feedback Sending Chubb Documents

We strive to live up to our high standards of service excellence with every claim A survey will be sent on all paid and closed claims and we look forward to hearing back from you

Ninety six percent of our Masterpiece Automobile Insurance customers who have had a paid claim and responded to our survey indicate they were ldquohighly satisfiedrdquo with their auto insurance claim experience

We value your business and your feedback is important to us

Your Records

We recommend that you create a file for important information related to your claim Throughout this process keep records of your claim documents to share with your agent and Chubb Claim Adjuster including

bull Your claim number bull Your Chubb Claim Adjusterrsquos name

and contact information bull Contact and insurance information

for other parties involved including witnesses

bull Repair estimates and bills bull Photographs of damage bull Receipts

Online Upload Using your claim reference number you can upload important documents directly to your claim file Visit Chubbrsquos claim document upload application at wwwchubbcomuploadclaimdoc

View Your Claim Details Online

When you register your Chubb Masterpiece accounts online you can access and manage your claim anytime anywhere Log in to your online account and click the Your Claims folder to

bull Review the details of your claim bull Locate your Chubb Claim Adjusterrsquos

contact information bull Check the status of your claim learn

about the process and understand next steps

bull Upload documents and photos to your claim file

bull Locate a nearby Chubb network collision repair facility

bull Review payment details bull Get answers to common claims

questions

If you have not done so already you can register your policies online at wwwchubbcom

Based on Chubb Masterpiece Automobile claim survey results from 2015

Evaluations reports and recommendations are made solely to assist Chubb in underwriting and loss control Evaluation of any hazard or condition does not mean that it is covered under any policy No warranties or representations of any kind are made to any party Neither Chubb nor its employees or agents shall be liable to any party for the use of any information or statements made or contained in any evaluation report or recommendation

copy2016 Chubb is the marketing name used to refer to subsidiaries of Chubb Limited providing insurance and related services For a list of these subsidiaries please visit our website at newchubbcom Insurance provided by US based Chubb underwriting companies This literature is descriptive only Coverage is subject to the language of the policies as actually issued Chubb Personal Risk Services PO Box 1600 Whitehouse Station NJ 08889-1600 Form 01-01-1367 (Rev 816)

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Accident Worksheet

The moments following an accident can be difficult but it is important to remain calm and capture as much information at the scene of an accident as possible Report all accidents to Chubb or your agent immediately

18002524670 for Chubb Masterpiece policyholders 18009457461 for ACE PRS and Firemanrsquos Fund policyholders

Accident Checklist

Take photos Your vehicle and any other vehicles involved in the accident ndash including photos of the license plates

General accident scene including other objects the car came in contact with street signs traffic signals intersections etc

Take notes Describe the accident and the damage to your car and any other vehicle(s) person(s) or object(s) involved

Obtain vehicle and driver information for others involved in the accident andor witnesses including name contact and insurance information

Name and precinct of the police officer at the scene of the accident

Accident Notes

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Accident Notes

Evaluations reports and recommendations are made solely to assist Chubb in underwriting and loss control Evaluation of any hazard or condition does not mean that it is covered under any policy No warranties or representations of any kind are made to any party Neither Chubb nor its employees or agents shall be liable to any party for the use of any information or statements made or contained in any evaluation report or recommendation

copy2016 Chubb is the marketing name used to refer to subsidiaries of Chubb Limited providing insurance and related services For a list of these subsidiaries please visit our website at newchubbcom Insurance provided by US based Chubb underwriting companies This literature is descriptive only Coverage is subject to the language of the policies as actually issued Chubb Personal Risk Services PO Box 1600 Whitehouse Station NJ 08889-1600 Form 01-01-1368 (Rev 816)

Page 5: The Auto Claim Experience and Accident Worksheet€¦ · • Exchange insurance and contact information with anyone involved or witnesses to the accident. Use the Accident Worksheet

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Accident Worksheet

The moments following an accident can be difficult but it is important to remain calm and capture as much information at the scene of an accident as possible Report all accidents to Chubb or your agent immediately

18002524670 for Chubb Masterpiece policyholders 18009457461 for ACE PRS and Firemanrsquos Fund policyholders

Accident Checklist

Take photos Your vehicle and any other vehicles involved in the accident ndash including photos of the license plates

General accident scene including other objects the car came in contact with street signs traffic signals intersections etc

Take notes Describe the accident and the damage to your car and any other vehicle(s) person(s) or object(s) involved

Obtain vehicle and driver information for others involved in the accident andor witnesses including name contact and insurance information

Name and precinct of the police officer at the scene of the accident

Accident Notes

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Accident Notes

Evaluations reports and recommendations are made solely to assist Chubb in underwriting and loss control Evaluation of any hazard or condition does not mean that it is covered under any policy No warranties or representations of any kind are made to any party Neither Chubb nor its employees or agents shall be liable to any party for the use of any information or statements made or contained in any evaluation report or recommendation

copy2016 Chubb is the marketing name used to refer to subsidiaries of Chubb Limited providing insurance and related services For a list of these subsidiaries please visit our website at newchubbcom Insurance provided by US based Chubb underwriting companies This literature is descriptive only Coverage is subject to the language of the policies as actually issued Chubb Personal Risk Services PO Box 1600 Whitehouse Station NJ 08889-1600 Form 01-01-1368 (Rev 816)

Page 6: The Auto Claim Experience and Accident Worksheet€¦ · • Exchange insurance and contact information with anyone involved or witnesses to the accident. Use the Accident Worksheet

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Accident Notes

Evaluations reports and recommendations are made solely to assist Chubb in underwriting and loss control Evaluation of any hazard or condition does not mean that it is covered under any policy No warranties or representations of any kind are made to any party Neither Chubb nor its employees or agents shall be liable to any party for the use of any information or statements made or contained in any evaluation report or recommendation

copy2016 Chubb is the marketing name used to refer to subsidiaries of Chubb Limited providing insurance and related services For a list of these subsidiaries please visit our website at newchubbcom Insurance provided by US based Chubb underwriting companies This literature is descriptive only Coverage is subject to the language of the policies as actually issued Chubb Personal Risk Services PO Box 1600 Whitehouse Station NJ 08889-1600 Form 01-01-1368 (Rev 816)